Individual
ELLEN MARY COREY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
627 S GRACE ST., LOMBARD, IL 60148
(331) 481-1406
Mailing address
627 S GRACE ST, LOMBARD, IL 60148-3509
(331) 481-1406
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
18-63456
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18-63456
RBT
IL
Enumeration date
10/02/2018
Last updated
10/02/2018
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